Provider Demographics
NPI:1902203441
Name:PROACTIVE NURSING, INC.
Entity Type:Organization
Organization Name:PROACTIVE NURSING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GEMMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORSUELO
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:619-887-2838
Mailing Address - Street 1:2345 E 8TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2868
Mailing Address - Country:US
Mailing Address - Phone:619-887-2838
Mailing Address - Fax:
Practice Address - Street 1:8692 WAGERS CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5027
Practice Address - Country:US
Practice Address - Phone:619-887-2838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-27
Last Update Date:2014-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty